Comparison of Incidence, Predictors, and the Impact of Co-Morbidity and Polypharmacy on the Risk of Recurrent Syncope in Patients <85 Versus ≥85 Years of Age

• Published in: The American journal of cardiology Vol. 112; no. 10; pp. 1610 - 1615
• Main Authors: Ruwald, Martin Huth, MD, PhD, Hansen, Morten Lock, MD, PhD, Lamberts, Morten, MD, Hansen, Carolina Malta, MD, Numé, Anna-Karin, MB, Vinther, Michael, MD, PhD, Køber, Lars, MD, DMSc, Torp-Pedersen, Christian, MD, DMSc, Hansen, Jim, MD, DMSc, Gislason, Gunnar Hilmar, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-11-2013; Elsevier Limited
• Subjects: Age; Aged; Aged, 80 and over; Cardiac arrhythmia; Cardiovascular; Cardiovascular Agents - therapeutic use; Codes; Comorbidity; Confidence intervals; Denmark - epidemiology; Diabetes; Enzymes; Fainting; Female; Gender; Hospitalization; Hospitals; Humans; Male; Middle Aged; Morbidity; Older people; Patients; Polypharmacy; Prevalence; Proportional Hazards Models; Psychotropic drugs; Registries; Risk Assessment - methods; Risk Factors; Survival Rate - trends; Syncope - drug therapy; Syncope - epidemiology; Syncope - physiopathology; Denmark
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.07.041

Recurrent syncope is a major cause of hospitalizations and may be associated with cardiovascular co-morbidities. Despite this, prognostic factors and the clinical characteristics among patients are not well described. Therefore, we identified and analyzed data on all patients >50 years of age discharged after a first-time episode of syncope in the period 2001 to 2009 through nationwide administrative registries. We identified the clinical characteristics of 5,141 patients ≥85 years of age and 23,454 patients <85 years of age. Multivariate Cox models were used to assess prognostic factors associated with the end point of recurrent syncope according to age. We found that those with syncope and ≥85 years were more often women (65% vs 47%) and generally had a greater prevalence of noncardiovascular co-morbidities, whereas the prevalence of cardiovascular co-morbidities was more heterogeneously distributed across age groups. Overall, significant baseline predictors of recurrent syncope were aortic valve stenosis (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.31 to 1.68), impaired renal function (HR 1.34, 95% CI 1.15 to 1.58), atrioventricular or left bundle branch block (HR 1.32, 95% CI 1.16 to 1.51), male gender (HR 1.18, 95% CI 1.12 to 1.24), chronic obstructive pulmonary disorder (HR 1.10, 95% CI 1.02 to 1.19), heart failure (HR 1.10, 95% CI 1.02 to 1.21), atrial fibrillation (HR = 1.09, 95% CI 1.01 to 1.19), age per 5-year increment (HR 1.09, 95% CI 1.07 to 1.10), and orthostatic medications per increase (HR 1.06, 95% CI 1.03 to 1.09). Atrial fibrillation and impaired renal function both exhibited less prognostic importance for recurrent syncope in the elderly compared with younger population (p for interactions <0.01). In conclusion, predictive factors of recurrent syncope were closely associated with increased cardiovascular risk profile age and gender. The use of multiple orthostatic medications additively increased the risk of recurrences representing a need for strategies to reduce unnecessary polypharmacy.